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Understanding alcoholism and alcohol abuse
Alcoholism and alcohol abuse are due to many interconnected factors, including genetics, how you were raised, your social environment, and your emotional health. People who have a family history of alcoholism or who associate closely with heavy drinkers are more likely to develop drinking problems. Finally, those who suffer from a mental health problem such as anxiety, depression, or bipolar disorder are also particularly at risk, because alcohol may be used to self-medicate.
Do you have a drinking problem?
You may have a drinking problem if you…
- Feel guilty or ashamed about your drinking.
- Lie to others or hide your drinking habits.
- Have friends or family members who are worried about your drinking.
- Need to drink in order to relax or feel better.
- “Black out” or forget what you did while you were drinking.
- Regularly drink more than you intended to.
Since drinking is so common in many cultures and the effects vary so widely from person to person, it’s not always easy to figure out where the line is between social drinking and problem drinking. The bottom line is how alcohol affects you. If your drinking is causing problems in your life, you have a drinking problem.
Signs and symptoms of alcohol abuse
Substance abuse experts make a distinction between alcohol abuse and alcoholism (also called alcohol dependence). Unlike alcoholics, alcohol abusers have some ability to set limits on their drinking. However, their alcohol use is still self-destructive and dangerous to themselves or others.
Common signs and symptoms of alcohol abuse include:
- Repeatedly neglecting your responsibilities at home, work, or school because of your drinking.For example, performing poorly at work, flunking classes, neglecting your kids, or skipping out on commitments because you’re hung over.
- Using alcohol in situations where it’s physically dangerous, such as drinking and driving, operating machinery while intoxicated, or mixing alcohol with prescription medication against doctor’s orders.
- Experiencing repeated legal problems on account of your drinking. For example, getting arrested for driving under the influence or for drunk and disorderly conduct.
- Continuing to drink even though your alcohol use is causing problems in your relationships.Getting drunk with your buddies, for example, even though you know your wife will be very upset, or fighting with your family because they dislike how you act when you drink.
- Drinking as a way to relax or de-stress. Many drinking problems start when people use alcohol to self-soothe and relieve stress. Getting drunk after every stressful day, for example, or reaching for a bottle every time you have an argument with your spouse or boss.
Health Risks of Excessive Drinking
Heavy drinking can cause the number of oxygen-carrying red blood cells to be abnormally low. This condition, known as anemia, can trigger a host of symptoms, including fatigue, shortness of breath, and lightheadedness.
“Habitual drinking increases the risk of cancer,” says Jurgen Rehm, PhD, chairman of the University of Toronto’s department of addiction policy and a senior scientist at the Centre for Addiction and Mental Health, also in Toronto. Scientists believe the increased risk comes when the body converts alcohol into acetaldehyde, a potent carcinogen. Cancer sites linked to alcohol use include the mouth, pharynx (throat), larynx (voice box), esophagus, liver, breast, and colorectal region. Cancer risk rises even higher in heavy drinkers who also use tobacco.
Heavy drinking, especially bingeing, makes platelets more likely to clump together into blood clots, which can lead to heart attack or stroke. In a landmark study published in 2005, Harvard researchers found that binge drinking doubled the risk of death among people who initially survived a heart attack.Heavy drinking can also cause cardiomyopathy, a potentially deadly condition in which the heart muscle weakens and eventually fails, as well as heart rhythm abnormalities such as atrial and ventricular fibrillation. Atrial fibrillation, in which the heart’s upper chambers (atria) twitch chaotically rather than constrict rhythmically, can cause blood clots that can trigger a stroke. Ventricular fibrillation causes chaotic twitching in the heart’s main pumping chambers (ventricles). It causes rapid loss of consciousness and, in the absence of immediate treatment, sudden death.
Alcohol is toxic to liver cells, and many heavy drinkers develop cirrhosis, a sometimes-lethal condition in which the liver is so heavily scarred that it is unable to function. But it’s hard to predict which drinkers will develop cirrhosis. “Some people who drink huge amounts never get cirrhosis, and some who don’t drink very much do get it,” Saitz says. For some unknown reason, women seem to be especially vulnerable.
As people age, their brains shrink, on average, at a rate of about 1.9% per decade. That’s considered normal. But heavy drinking speeds the shrinkage of certain key regions in the brain, resulting in memory loss and other symptoms of dementia.
Heavy drinking can also lead to subtle but potentially debilitating deficits in the ability to plan, make judgments, solve problems, and perform other aspects of “executive function,” which are “the higher-order abilities that allow us to maximize our function as human beings,” Garbutt says.
In addition to the “nonspecific” dementia that stems from brain atrophy, heavy drinking can cause nutritional deficiencies so severe that they trigger other forms of dementia.
It’s long been known that heavy drinking often goes hand in hand with depression, but there has been debate about which came first — the drinking or the depression. One theory is that depressed people turned to alcohol in an attempt to “self-medicate” to ease their emotional pain. But a large study from New Zealand showed that it was probably the other way around — that is, heavy drinking led to depression.
Research has also shown that depression improves when heavy drinkers go on the wagon, Saitz says.
Heavy drinking can cause epilepsy and can trigger seizures even in people who don’t have epilepsy. It can also interfere with the action of the medications used to treat convulsions.
A painful condition, gout is caused by the formation of uric acid crystals in the joints. Although some cases are largely hereditary, alcohol and other dietary factors seem to play a role. Alcohol also seems to aggravate existing cases of gout.
High blood pressure
Alcohol can disrupt the sympathetic nervous system, which, among other things, controls the constriction and dilation of blood vessels in response to stress, temperature, exertion, etc. Heavy drinking — and bingeing, in particular — can cause blood pressure to rise. Over time, this effect can become chronic. High blood pressure can lead to many other health problems, including kidney disease, heart disease, and stroke.
Heavy drinking suppresses the immune system, providing a toehold for infections, including tuberculosis, pneumonia, HIV/AIDS, and other sexually transmitted diseases (including some that cause infertility). People who drink heavily also are more likely to engage in risky sex. “Heavy drinking is associated with a three-fold increase in the risk of contracting a sexually transmitted disease,” Rehmn says.
Heavy drinking can cause a form of nerve damage known as alcoholic neuropathy, which can produce a painful pins-and-needles feeling or numbness in the extremities as well as muscle weakness, incontinence, constipation, erectile dysfunction, and other problems. Alcoholic neuropathy may arise because alcohol is toxic to nerve cells, or because nutritional deficiencies attributable to heavy drinking compromise nerve function.
In addition to causing stomach irritation (gastritis), drinking can inflame the pancreas. Chronic pancreatitis interferes with the digestive process, causing severe abdominal pain and persistent diarrhea –and “it’s not fixable,” Saitz says. Some cases of chronic pancreatitis are triggered by gallstones, but up to 60% stem from alcohol consumption.
Alcohol Addiction Treatment & Self-Help
Alcohol treatment and recovery 1: Commit to stop drinking
Most people with alcohol problems do not decide to make a big change out of the blue or transform their drinking habits overnight. Recovery is usually a more gradual process. In the early stages of change, denial is a huge obstacle. Even after admitting you have a drinking problem, you may make excuses and drag your feet. It’s important to acknowledge your ambivalence about stopping drinking. If you’re not sure if you’re ready to change or you’re struggling with the decision, it can help to think about the costs and benefits of each choice.
Evaluating the costs and benefits of drinking
Make a table like the one below, weighing the costs and benefits of drinking to the costs and benefits of quitting.
|Is Drinking Worth The Cost?|
|Benefits of drinking:||Benefits of not drinking:|
|Costs of drinking:||Costs of not drinking:|
Alcohol treatment and recovery 2: Set goals and prepare for change
Once you’ve made the decision to change, the next step is establishing clear drinking goals. The more specific, realistic, and clear your goals, the better.
|Example #1: My drinking goal|
|Example #2: My drinking goal|
- Do you want to stop drinking altogether or just cut back? If your goal is to reduce your drinking, decide which days you will drink alcohol and how many drinks you will allow yourself per day. Try to commit to at least two days each week when you won’t drink at all.
- When do you want to stop drinking or start drinking less? Tomorrow? In a week? Next month? Within six months? If you’re trying to stop drinking, set a specific quit date.
After you’ve set your goals to either stop or cut back your drinking, write down some ideas on how you can help yourself accomplish these goals. For example:
- Get rid of temptations. Remove all alcohol, barware, and other drinking reminders from your home and office.
- Announce your goal. Let friends, family members, and co-workers know that you’re trying to stop drinking. If they drink, ask them to support your recovery by not doing so in front of you.
- Be upfront about your new limits. Make it clear that drinking will not be allowed in your home and that you may not be able to attend events where alcohol is being served.
- Avoid bad influences. Distance yourself from people who don’t support your efforts to stop drinking or respect the limits you’ve set. This may mean giving up certain friends and social connections.
- Learn from the past. Reflect on previous attempts to stop drinking. What worked? What didn’t? What can you do differently this time to avoid pitfalls?
Can I cut back on my drinking or do I need to stop drinking completely?
Whether or not you can successfully cut back on your drinking depends on the severity of your drinking problem.
If you’re an alcoholic—which, by definition, means you aren’t able to control your drinking—it’s best to try to stop drinking entirely. But if you’re not ready to take that step, or if you don’t have an alcohol abuse problem but want to cut back for personal or health reasons, the following tips adapted from the National Institute on Alcohol Abuse and Alcoholism can help:
- Set a drinking goal. Choose a limit for how much you will drink. Make sure your limit is not more than one drink a day if you’re a woman, or two drinks a day if you’re a man. Now write your drinking goal on a piece of paper. Put it where you can see it, such as on your refrigerator or bathroom mirror.
- Keep a “diary” of your drinking. To help you reach your goal, keep a “diary” of your drinking. For example, write down every time you have a drink for 1 week. Try to keep your diary for 3 or 4 weeks. This will show you how much you drink and when. You may be surprised. How different is your goal from the amount you drink now?
- Watch it at home. Keep a small amount or no alcohol at home. Don’t keep temptations around.
- Drink slowly. When you drink, sip your drink slowly. Take a break of 1 hour between drinks. Drink soda, water, or juice after a drink with alcohol. Do not drink on an empty stomach! Eat food when you are drinking.
- Take a break from alcohol. Pick a day or two each week when you will not drink at all. Then, try to stop drinking for 1 week. Think about how you feel physically and emotionally on these days. When you succeed and feel better, you may find it easier to cut down for good.
Alcohol treatment and recovery 3: Get sober safely
Some people can stop drinking on their own, while others need medical supervision in order to withdraw from alcohol safely and comfortably. Which option is best for you depends on how much you’ve been drinking, how long you’ve had a problem, and other health issues you may have.
Withdrawing from alcohol
When you drink heavily and frequently, your body becomes physically dependent on alcohol and goes through withdrawal if you suddenly stop drinking. The symptoms of alcohol withdrawal range from mild to severe, and include:
- Nausea or vomiting
- Anxiety and restlessness
- Stomach cramps and diarrhea
- Trouble sleeping or concentrating
- Elevated heart rate and blood pressure
Alcohol withdrawal symptoms usually start within hours after you stop drinking, peak in a day or two, and improve within five days. But in some alcoholics, withdrawal is not just unpleasant—it can be life threatening.
Call your doctor or go to the emergency room if you experience any of the following withdrawal symptoms:
- severe vomiting
- confusion and disorientation
- extreme agitation
- seizures or convulsions
The symptoms listed above may be a sign of a severe form of alcohol withdrawal called delirium tremens, or DTs. This rare, emergency condition causes dangerous changes in the way your brain regulates your circulation and breathing, so it’s important to get to the hospital right away.
Do I need to go to detox?
If you’re a long-term, heavy drinker, you may need medically supervised detoxification. Detox can be done on an outpatient basis or in a hospital or alcohol treatment facility, where you may be prescribed medication to prevent medical complications and relieve withdrawal symptoms. Talk to your doctor or an addiction specialist to learn more.
Alcohol treatment and recovery 4: Find new meaning in life
While getting sober is an important first step, it is only the beginning of alcohol recovery. Rehab or professional treatment can get you started on the road to recovery, but to stay alcohol-free for the long term, you’ll need to build a new, meaningful life where drinking no longer has a place.
5 steps to a sober lifestyle
- Take care of yourself. To prevent mood swings and combat cravings, concentrate on eating right and getting plenty of sleep. Exercise is also key: it releases endorphins, relieves stress, and promotes emotional well-being.
- Build your support network. Surround yourself with positive influences and people who make you feel good about yourself. The more you’re invested in other people and your community, the more you have to lose—which will help you stay motivated and on the recovery track.
- Develop new activities and interests. Find new hobbies, volunteer activities, or work that gives you a sense of meaning and purpose. When you’re doing things you find fulfilling, you’ll feel better about yourself and drinking will hold less appeal.
- Continue treatment. Your chances of staying sober improve if you are participating in a support group like Alcoholics Anonymous, have a sponsor, or are involved in therapy or an outpatient treatment program.
- Deal with stress in a healthy way. Alcohol abuse is often a misguided attempt to manage stress. Find healthier ways to keep your stress level in check, such as exercising, meditating, or practicing breathing exercises or other relaxation techniques.
Alcohol treatment and recovery 5: Handle triggers and cravings
Cravings for alcohol can be intense, particularly in the first six months after you quit drinking. Good alcohol treatment prepares you for these challenges, helping you develop new coping skills to deal with stressful situations, alcohol cravings, and social pressure to drink.
Avoiding drinking triggers
- Avoid the things that trigger your urge to drink. If certain people, places, or activities trigger a craving for alcohol, try to avoid them. This may mean making major changes to your social life, such as finding new things to do with your old drinking buddies—or even giving up those friends.
- Practice saying “no” to alcohol in social situations. No matter how much you try to avoid alcohol, there will probably be times where you’re offered a drink. Prepare ahead for how you’ll respond, with a firm, yet polite, “no thanks.”
Managing alcohol cravings
When you’re struggling with alcohol cravings, try these strategies:
- Talk to someone you trust: your sponsor, a supportive family member or friend, or someone from your faith community.
- Distract yourself until the urge passes. Go for a walk, listen to music, do some housecleaning, run an errand, or tackle a quick task.
- Remind yourself of your reasons for not drinking. When you’re craving alcohol, there’s a tendency to remember the positive effects of drinking and forget the negatives. Remind yourself that drinking won’t really make you feel better.
- Accept the urge and ride it out, instead of trying to fight it. This is known as “urge surfing.” Think of your craving as an ocean wave that will soon crest, break, and dissipate. When you ride out the craving, without trying to battle, judge, or ignore it, you’ll see that it passes more quickly than you’d think.
The 3 basic steps of urge surfing:
- Take an inventory of how you experience the craving. Do this by sitting in a comfortable chair with your feet flat on the floor and your hands in a comfortable position. Take a few deep breaths and focus your attention inward. Allow your attention to wander through your body. Notice where in your body you experience the craving and what the sensations are like. Notice each area where you experience the urge, and tell yourself what you are experiencing. For example, “My craving is in my mouth and nose and in my stomach.”
- Focus on one area where you are experiencing the urge. Notice the exact sensations in that area. For example, do you feel hot, cold, tingly, or numb? Are your muscles tense or relaxed? How large an area is involved? Notice the sensations and describe them to yourself. Notice the changes that occur in the sensation. “My mouth feels dry and parched. There is tension in my lips and tongue. I keep swallowing. As I exhale, I can imagine the smell and tingle of booze.”
- Repeat the focusing with each part of your body that experiences the craving. Describe to yourself the changes that occur in the sensations. Notice how the urge comes and goes. Many people, when they urge surf, notice that after a few minutes the craving has vanished. The purpose of this exercise, however, is not to make the craving go away but to experience the craving in a new way. If you practice urge surfing, you will become familiar with your cravings and learn how to ride them out until they go away naturally.
Source: National Institute on Alcohol Abuse and Alcoholism
Alcohol treatment and recovery 6: Get support
Whether you choose to go to rehab, rely on self-help programs, get therapy, or take a self-directed treatment approach, support is essential. Don’t try to go it alone. Recovering from alcohol addiction is much easier when you have people you can lean on for encouragement, comfort, and guidance.
Support can come from family members, friends, counselors, other recovering alcoholics, your healthcare providers, and people from your faith community.
- Lean on close friends and family – Having the support of friends and family members is an invaluable asset in recovery. If you’re reluctant to turn to your loved ones because you’ve let them down before, consider going to couples counseling or family therapy.
- Build a sober social network – If your previous social life revolved around alcohol, you may need to make some new connections. It’s important to have sober friends who will support your recovery. Try taking a class, joining a church or a civic group, volunteering, or attending events in your community.
- Consider moving in to a sober living home – Sober living homes provide a safe, supportive place to live while you’re recovering from alcohol addiction. They are a good option if you don’t have a stable home or an alcohol-free living environment to go to.
- Make meetings a priority – Join a recovery support group and attend meetings regularly. Spending time with people who understand exactly what you’re going through can be very healing. You can also benefit from the shared experiences of the group members and learn what others have done to stay sober.
Alcohol treatment and recovery 7: Getting started on treatment
As well as joining a recovery support group, you may also decide to see a mental health professional and take advantage of the latest addiction therapies and programs. As you consider the different options available, keep the following in mind:
- There’s no magic bullet or single treatment that works for everyone. Everyone’s needs are different, so it’s important that you find a program that feels right to you. Any alcohol addiction treatment program should be customized to your unique problems and situation.
- Treatment should address more than just your alcohol abuse. Addiction affects your whole life, including your relationships, career, health, and psychological well-being. Treatment success depends on examining the way alcohol abuse has impacted you and developing a new way of living.
- Seek treatment for any other medical or psychological issues you’re experiencing. Alcohol abuse frequently goes hand in hand with other mental health problems, including anxiety, depression, attention deficit disorder, and bipolar disorder. In many cases, the drinking is an attempt to self-medicate. When these problems co-occur, recovery depends on treating them both.
- Commitment and follow-through are key. Recovering from alcohol addiction is not a quick and easy process. In general, the longer and more intense the alcohol use, the longer and more intense the treatment you’ll need. But regardless of the treatment program’s length in weeks or months, long-term follow-up care is crucial to recovery.
- There are many places to turn for help. Not everybody requires medically supervised detox or an extended stint in rehab. The level of care you need depends on your age, alcohol use history, and other medical or psychiatric conditions. In addition to doctors and psychologists, many clergy members, social workers, and counselors offer addiction treatment services.
Alcohol recovery is a process—one that often involves setbacks. Don’t give up if you relapse or slip. A drinking relapse doesn’t mean you’re a failure or that you’ll never be able to reach your goal. Each drinking relapse is an opportunity to learn and recommit to sobriety, so you’ll be less likely to relapse in the future.
What to do if you slip:
- Get rid of the alcohol and get away from the setting where you lapsed
- Remind yourself that one drink or a brief lapse doesn’t have to turn into a full-blown relapse
- Don’t let feelings of guilt, blame, or shame keep you from getting back on track
- Call your sponsor, counselor, or a supportive friend right away for help
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